Psikiatri Hostile

8/12/2019 Psikiatri Hostile

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Keterangan Umum

Nama : Ny LUmur : 42 thn

Alamat : Cianjur

Agama : IslamSuku : Sunda

Tgl masuk rshs : 17 Feruari 2!!7

Tgl "emeriksaan : 24 Feruari 2!!7

Alloanamnesa

Alasan "asien di#"name: i$ara kasar dan memukul anak%anaknya

&s menyatakan diri #s adalah 'anita yang ter$antik( sehingga)urang leih tahun

2!!4 sejak suami #s meninggal( #s menjadi sering melamun( menarik diri( dan leih

"endiam dari iasanya* )urang leih + ulan ,seelum- suami #s meninggal( #s leihanyak eri$ara dan sering menyatakan keinginan untuk menikah lagi* anyak "ria yang

menginginkannnya%%%%%%%%*dan%%%%%%%%( sehingga akhirnya di#ati #leh se#rang "sikiaterdan dianjurkan dira'at di .S/************0era'atan kurang leih minggu( "ulang dengan

"eraikan* Se"ulang dari .S( #s tidak $#ntr#l lagi( karena sudah merasa sehat* Namun #s

gelisah lagi hingga akhirnya #s dira'at lagi di .S/***** leih kurang 1 ulan dira'at( dan"ulang dengan "eraikan* &s minum #at teratur( namun ulan S3.S( #s tidak mau

minum #at lagi( karena merasa sudah sehat* Se'aktu #s erjalan( #s tertarak m#t#r*

Sejak saat itu #s makin menjadi "endiam dan menyendiri* ingga akhirnya leih kurang

2 ulan S3.S #s menjadi gelisah lagi( i$ara kasar( memukul anaknya dan akhirnya #sdirujuk ke .SS*

Riwayat Penyakit Sebelumnya:

Se'aktu di $ianjur #s menda"at tera"i C05 261!!mg( .es"erid#l 261*

Riwayat penyakit dalam keluarga:Tidak ada

Riwayat Trauma kepala, kejang, patah tulang :Tidak ada

Riwayat hidup penderita

3asa di kandungan dan sekitar "ersalinan : elum diketahui "asti3asa ayi : elum diketahui "asti

3asa "rasek#lah : elum diketahui "asti

3asa sek#lah dan "ra"uertas : elum diketahui "asti3asa "uertas : elum diketahui "asti

3asa de'asa : elum diketahui "asti

3asa tua : #s elum memasuki usia tua


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Riwayat pekerjaan:&s tidak ekerja

Riwayat perkawinan :menikah 2! tahun yang lalu ,18+- dan dikaruniai + anak*

uungan #s dengan suami sangat aik* Suami ekerja seagai "ega'ai negrisi"il di 0emda Cianjur* Seelum suami meninggal kehidu"an #s dan keluarga sangat aik

Namun sejak suami meninggal #s diketahui%%%%%%%%%%%% jika keluarga mengalami kesulitan

iaya* Anak #s yang "ertama tidak melanjutkan sek#lah*

Kepribadian sebelum sakit

&s erke"riadian $eria dan mudah ergaul

Moral, agama, sosial :aik

ubungan sosialSeelum sakit #s akti9 di kegiatan agama

!!" Ski#"hrenia 0aran#id

Ski#a9ekti9

Pemeriksaan lanjutan:

#ab :( Leuk#sit( Ureum( )reatinin( S;&T( S;0T( ;ula darah se'aktu(


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meninggal(&s sering mendengar suara yang menginstruksikan #s untuk er"uasa dan

eriadah*Setelah er"uasa dan eriadah itu(#s merasa dirinya er$ahaya yang kelihatan

terutama "ada jam 12 malam*&s mengaku suaminya eristri em"at dan #s meru"akan istri yang "ertama*&s

tidak "ernah merasa sedih tentang hal itu dan mem"unyai huungan yang aik dengan

istri suaminya yang lain*0ada saat ini(#s merasa dirinya tidak sakit a"a"un*

Treatment

The 9#ll#'ing ad>erse e99e$ts are th#se ty"i$ally ass#$iated 'ith $#n>enti#nal

anti"sy$h#ti$ agents #r 'ith ris"erid#ne at d#ses greater than + mgBd*

Akathisia ,2%7- is a suje$ti>e sense #9 inner restlessness( mental

unease( irritaility( and dys"h#ria*

?yst#nia is the #$$urren$e #9 "ain9ul and 9rightening mus$le $ram"s that

usually #$$ur 'ithin 12%48 h#urs #9 the eginning #9 treatment #r anin$rease in d#se* This ty"i$ally #$$urs in y#ung mus$ular men in the head

and ne$k( ut it may e6tend t# the trunk and lims

y"er"r#la$tinemia is ass#$iated 'ith gala$t#rrhea( amen#rrhea(

gyne$#mastia( im"#ten$e( and #ste#"#r#sis*

0atients 'ith neur#le"ti$ malignant syndr#me "resent 'ith hy"erthermia(

mus$ular rigidity( altered mental state( and aut#n#mi$ instaility*

La#rat#ry 9indings in$lude in$reased $reatine kinase and my#gl#inuria*

A$ute renal 9ailure may e "resent* A signi9i$ant m#rtality rate e6ists* .arere"#rts #9 $l#a"ine%ass#$iated neur#le"ti$ malignant syndr#me ha>e een

made*

0arkins#nism ,!- "resents 'ith trem#r( radykinesia( akinesia( and(

s#metimes( rigidity #r rady"hrenia* This #$$urs "arti$ularly in '#men

and elderly "atients*

Tardi>e dyskinesia

The in$iden$e #9 tardi>e dyskinesia ,T?- is as high as 7! in

elderly "atients* It "resents as in>#luntary and re"etiti>e ,ut n#t

rhythmi$- m#>ements #9 the m#uth and 9a$e* Che'ing( su$king(

grima$ing( #r "#uting m#>ements #9 the 9a$ial mus$les may #$$ur*0e#"le may r#$k a$k and 9#rth #r ta" their 9eet* &$$asi#nally(

dia"hragmati$ dyskinesia e6ists( 'hi$h leads t# l#ud and irregulargas"ing* The "atient is #9ten n#t a'are #9 these m#>ements*

.isk 9a$t#rs 9#r T? in$lude age( 9emale se6( l#'er intelligen$e

Du#tient ,I=-( and negati>e sym"t#ms* ?urati#n #9 thera"y and

d#se seem t# e l#gi$al risk 9a$t#rs( ut this has n#t een

dem#nstrated $#n$lusi>ely*


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Use #9 n#>el anti"sy$h#ti$ drugs is assumed t# result in a de$line in

the in$iden$e #9 T?( ut( until many "atients ha>e een e6"#sed t#these drugs 9#r se>eral years( this 'ill n#t e kn#'n 'ith $ertainty*

The 9#ll#'ing ad>erse e99e$ts may #$$ur 'ith all anti"sy$h#ti$ agents( e6$e"t as

n#ted*

Anti$h#linergi$ ad>erse e99e$ts in$lude dry m#uth( e6a$erati#n #9

glau$#ma( $#n9usi#n( de$reased mem#ry( agitati#n( >isual hallu$inati#ns(

and $#nsti"ati#n* .is"erid#ne and i"rasid#ne are 9ree #9 anti$h#linergi$

ad>erse e99e$ts*

The =T inter>al is the ele$tr#$ardi#gram inter>al et'een the eginning #9the =.S $#m"le6 and the end #9 the T 'a>e* It re9le$ts the time reDuired

9#r the >entri$les t# de"#larie and re"#larie* A "r#l#nged =T inter>al

"uts a "ers#n at risk 9#r t#rsades de "#intes( a "#tentially lethal arrhythmia*Ehen the =T is $#rre$ted 9#r heart rate( it is $alled =T$* =T$ inter>als are

lengthened y the $#n>enti#nal anti"sy$h#ti$ agents thi#ridaine(

"im#ide( and mes#ridaine and( t# a lesser e6tent( y the n#>elanti"sy$h#ti$ agent i"rasid#ne*

All anti"sy$h#ti$ agents may e ass#$iated 'ith es#"hageal dysm#tility(

as"irati#n( and the risk #9 "neum#nia*

;lu$#se and li"id meta#lism $hanges may #$$ur 'ith all agents ut are"arti$ularly tr#ules#me 'ith $l#a"ine and #lana"ine ,'ith #r 'ith#ut

'eight gain-*

&rth#stati$ hy"#tensi#n $an e "r#lemati$ at the eginning #9 thera"y(

'ith d#se in$reases( and in elderly "atients* This is related t# al"ha1%

l#$kade and is "arti$ularly se>ere 'ith ris"erid#ne and $l#a"ine*

en#us thr#m#em#lism may e ass#$iated 'ith the use #9 anti"sy$h#ti$

drugs* ?ata 9r#m S'eden suggest that "atients treated 'ith $l#a"ine maye at "arti$ular risk 9#r this $#m"li$ati#n* The reas#ns 9#r this "#ssile

ass#$iati#n are n#t underst##d*

Eeight gain may #$$ur 'ith all agents ut is "arti$ularly tr#ules#me 'ith

$l#a"ine and #lana"ine* 3#lind#ne( ris"erid#ne( and i"rasid#ne may e

the anti"sy$h#ti$ drugs least likely t# lead t# this ad>erse e99e$t* The

me$hanism #9 'eight gain ass#$iated 'ith "sy$h#tr#"i$ drugs is n#t

underst##d* Sensiti>ity t# insulin may e in$reased( #r in$reased le"tinle>els may e "resent* Eeight gain is ass#$iated #th 'ith "sy$h#l#gi$al

"r#lems ,eg( de$reased sel9%esteem- and 'ith medi$al "r#lems ,eg(diaetes( $#r#nary artery disease( arthritis-* S#me a""r#a$hes t# the"r#lem #9 'eight gain in$lude edu$ati#nal "r#grams #n nutriti#n and

e6er$ise( $#gniti>e eha>i#ral thera"y( #r the additi#n #9 #ther

medi$ati#ns( su$h as amantadine #r niatidine* The e99i$a$y #9 addingmedi$ati#ns has n#t yet een estalished*


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he $#n>enti#nal anti"sy$h#ti$ agents ha>e m#re ad>erse e99e$ts than the ne'er agentsG

h#'e>er( they "#ssess s#me ad>antages* ailale in generi$ 9#rms(

they are less e6"ensi>e* They are a>ailale in a >ariety #9 >ehi$les( in$luding liDuid andintramus$ular "re"arati#ns* 3#st im"#rtantly( they are als# a>ailale as de"#t

"re"arati#ns* In #ther $#untries( se>eral di99erent anti"sy$h#ti$ de"#t "re"arati#ns e6ist(

ut( in the United States( #nly hal#"erid#l and 9lu"henaine are a>ailale in de"#t 9#rms*.is"erid#ne is n#' a>ailale as a l#ng%a$ting inje$ti#n that uses i#degradale "#lymers

and is $alled .is"erdal C#nsta*

al#"erid#l and 9lu"henaine de$an#ate $an e administered e>ery 2%4

'eeks* ?#ses range 9r#m !%2!! mgBm# 9#r hal#"erid#l de$an#ate and

12*%! mg e>ery 'eeks 9#r 9lu"henaine de$an#ate*

Anti$h#linergi$ agents ,eg( entr#"ine( "r#$y$lidine( trihe6y"henidyl(

di"henhydramine- #r amantadine are #9ten used in $#njun$ti#n 'ith the$#n>enti#nal anti"sy$h#ti$ agents t# "re>ent dyst#ni$ m#>ements #r t#

treat e6tra"yramidal sym"t#ms* Akathisia is "arti$ularly di99i$ult t# treat(

ut it #$$asi#nally res"#nds t# an anti$h#linergi$ agent( a en#diae"ine(#r a eta%l#$ker*

Cl#a"ine is the #ldest aty"i$al anti"sy$h#ti$ agent* It is #9ten re9erred t#

as the $riteri#n standard e$ause it is "r#aly the m#st e99e$ti>e

anti"sy$h#ti$ agent* It is ass#$iated 'ith a#ut a 1 risk #9agranul#$yt#sis( s# "atients must ha>e 'eekly 'hite l##d $ell $#unt

m#nit#ring 9#r the 9irst + m#nths ,the "eri#d #9 greatest risk- and then

m#nit#ring e>ery 2 'eeks* Cl#a"ine is als# ass#$iated 'ithanti$h#linergi$ ad>erse e99e$ts( sedati#n( and dr##ling* #'e>er(

a""r#6imately #ne third #9 "atients 'h# ha>e n#t res"#nded t#

$#n>enti#nal anti"sy$h#ti$ agents d# etter #n $l#a"ine* i#len$e(

sustan$e ause( sm#king( and sui$idality are diminished 'ith the use #9$l#a"ine*

3any "atients 'ith s$hi#"hrenia are treated 'ith "sy$h#tr#"i$ medi$ati#ns in

additi#n t# anti"sy$h#ti$ agents* ery little rig#r#us e>iden$e 9#r the utility #9"#ly"harma$y in s$hi#"hrenia e6ists( ut it is 'idely "ra$ti$ed* 3edi$ati#ns

#9ten used in$lude the antide"ressants( m##d stailiers( and an6i#lyti$ agents*

N#te that $aramae"ine and $l#a"ine sh#uld n#t e used t#gether* It is als#Duite $#mm#n t# use 2 di99erent anti"sy$h#ti$ agents t#gether( alth#ugh resear$h

t# su""#rt this is s$ant*

$onsultations:

S#$ial '#rk: S$hi#"hrenia a99e$ts the "ers#nHs 'h#le 9amily* The e99e$ts #9

9amilial @high e6"ressed em#ti#n ,h#stile #>erin>#l>ement and intrusi>eness- #n

the #ut$#me #9 "ers#ns 'ith s$hi#"hrenia 'h# return h#me ha>e generated

interest* S#me studies ha>e 9#und that 9amily thera"y #r 9amily inter>enti#ns may"re>ent rela"se( ut these 9indings ha>e n#t al'ays een re"li$ated*


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#$ati#nal rehailitati#n: Fe' "atients 'ith s$hi#"hrenia are ale t# maintain

$#m"etiti>e em"l#yment* Su""#rted em"l#yment "r#grams are ass#$iated 'ithhigher rates #9 em"l#yment ut n#t 'ith in$reases in gl#al 9un$ti#ning( sel9%

esteem( time #ut #9 the h#s"ital( #r Duality #9 li9e*

Nutriti#n: 3any "sy$h#tr#"i$ medi$ati#ns are ass#$iated 'ith 'eight gain and

$hanges in glu$#se #r li"id meta#lism( s# nutriti#nal $#unseling may e hel"9ul*

!iet:N# "arti$ular diet is re$#mmended* #'e>er( many "sy$h#tr#"i$ medi$ati#ns areass#$iated 'ith 'eight gain( s# nutriti#nal $#unseling may e hel"9ul*

A%ti&ity: erse e99e$ts #9 these drugs* Sm#king may als# e related t# the #red#m

ass#$iated 'ith h#s"italiati#ns( the "eer "ressure 9r#m #ther "atients t# sm#ke( #rthe #red#m ass#$iated 'ith unem"l#yment* In any $ase( the health risks 9r#m

sm#king are 'ell kn#'n( and "atients 'h# are s$hi#"hreni$ sh#uld e

en$#uraged t# st#" sm#king*

In>#l>ing "e#"le #utside the usual medi$al settings is als# hel"9ul* TheNati#nalAllian$e 9#r the 3entally Ill ,NA3I-is a hel"9ul ad>#$a$y gr#u" that is

su""#rti>e 9#r 9amily memers* NA3I als# ad>#$ates 9unding and resear$h*

0atients 'ith s$hi#"hrenia #9ten ha>e di99i$ulty 9inding h#usingG there9#re('#rking 'ith ass#$iati#ns that may "r#>ide h#using assistan$e is im"#rtant*
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Psikiatri Hostile